Clinical Review Specialist - Temporary

Who is Comprehensive Healthcare?
Comprehensive Healthcare provides innovative behavioral health and integrated healthcare services to clients of all ages. We take pride in our creative and collaborative work environment and in delivering clinically excellent, trauma-informed, recovery-oriented services.

What are we looking for in a Clinical Review Specialist?
The Clinical Review Specialist is responsible for ensuring that Comprehensive Healthcare receives treatment authorization from their designated payor for each client admitted to our residential, crisis, or evaluation & treatment facilities. This authorization is essential because it allows us to provide essential treatment to our clients, while also enabling us to successfully bill for the services we provide. The Clinical Review Specialist coordinates with insurance companies and managed care organizations to verify client insurance coverage upon intake and to provide necessary information to payors about their clients treatment in order to obtain and maintain treatment authorization for the entirety of each clients inpatient stay. By conducting thorough reviews of clinical records, the Clinical Review Specialist also ensures that appropriate levels of care and modalities are being provided for each client. This position requires exceptional interpersonal communication skills and working knowledge of insurance authorizations, levels of care, and utilization review. This is a non-clinical role that requires knowledge gained through prior experience in a clinical capacity. This position is expected to last 12-14 weeks with the possibility to become permanent. The schedule is Monday-Friday, 8am-5pm.

Clinical Review Specialist duties may include:

• verifying insurance for each client and coordinating with BHOs or other payors for treatment authorization if a client does not have coverage
• conducting reviews of clinical records and assisting with treatment planning to ensure that appropriate levels of care and modalities are being provided
• providing ongoing utilization management reviews for authorizing bodies in order to obtain continued authorization throughout the inpatient stay
• attending staff meetings at each facility to gather clinical information and provide insurance authorization status to the treatment teams
• monitoring and tracking different authorizing bodies to identify patterns of difficulties and develop plans for improvement
• providing training & guidance to treatment teams regarding necessary documentation and language for authorizations
• assisting with training staff and implementing new clinical programs in our residential, crisis, and evaluation & treatment facilities

Qualifications:

• Bachelor's degree in nursing, social work, psychology, or related field OR licensed in Washington as a Substance Use Disorder Professional
• Two years of clinical experience in a medical or behavioral health setting
• Working knowledge of current practices related to levels of care, quality improvement, and utilization management concepts

What Comprehensive Healthcare Can Offer You
Training and Development

• A variety of career opportunities in a wide range of settings with room for mobility and promotion
• Regular training opportunities including support, supervision, and consultation in implementing evidence-based services and programs

Innovative Program & Services

• A strong reputation for providing quality, evidence-based services within a collaborative multi-disciplinary team environment
• Innovative, forward-looking leadership that seeks to thrive in an ever-changing healthcare environment
• Joint Commission-accredited organization committed to continuous quality improvement
• Established partnerships with major research universities and other community and healthcare providers to implement cutting-edge treatment programs and services

Excellent Benefits

• Competitive salaries within our communities and industry
• Healthcare coverage for employee and qualified family members
• Generous vacation, paid holiday and sick leave policies
• Access to Employee Assistance Program services
• Agency-funded retirement plan with contributions equal to 5% of compensation
• Additional retirement investment opportunities with a 50% investment match of up to 4% of compensation
• Agency-funded life and disability insurance program
• Tuition reimbursement program to support staff pursuing additional education
• Employer-funded student loan repayment assistance

Comprehensive Healthcare is proud to be an equal opportunity employer. We do not discriminate based on race, sex, age, color, religion, national origin, sexual orientation, gender identity or expression, marital status, veteran status, disability status, or any other basis prohibited by federal, state, or local law. We value the diverse perspectives and strengths that our employees bring to the workplace and we encourage individuals from underrepresented groups to apply for our positions. The Human Resources department offers accommodations and assistance for the application and interview process; please contact us to make arrangements.